H. B. No. 176 As Reported by the House Finance and Appropriations Committee

As Reported by the House Finance and Appropriations Committee

130th General Assembly

Regular Session

2013-2014

H. B. No. 176

Representative Sears

A BILL

To amend section 101.391 and to enact sections

5111.0126, 5111.80, 5111.801, 5111.802, and

5111.947 of the Revised Code to require the

Medical Assistance Director to implement Medicaid

reforms, to permit the Medicaid program to cover

an additional group under certain circumstances,

to revise the duties of the Joint Legislative

Committee on Medicaid Technology and Reform, and

to make an appropriation.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That section 101.391 be amended and sections	10
5111.0126, 5111.80, 5111.801, 5111.802, and 5111.947 of the	11
Revised Code be enacted to read as follows:	12

Sec. 101.391. (A) There is hereby created the joint	13
legislative committee on medicaid technology and reform. The	14
committee may review or study any matter that it considers	15
relevant to the operation of the medicaid program established	16
under Chapter 5111. of the Revised Code, with priority given to	17
the study or review of ~~mechanisms~~both of the following:	18

(1) The reforms to be implemented under section 5111.80 of	19
the Revised Code;	20

(2) Mechanisms to enhance the program's effectiveness through	21
improved technology systems ~~and program reform~~.	22

(B)(1) The committee shall consist of ~~five~~the following	23
members:	24

(a) Three members of the house of representatives from the	25
majority party appointed by the speaker of the house of	26
representatives ~~and five~~;	27

(b) Two members of the house of representatives from the	28
minority party appointed by the speaker of the house of	29
representatives;	30

(c) Three members of the senate from the majority party	31
appointed by the president of the senate;	32

(d) Two members of the senate from the minority party	33
appointed by the president of the senate. ~~Not more than three~~	34
~~members appointed by the speaker of the house of representatives~~	35
~~and not more than three members appointed by the president of the~~	36
~~senate may be of the same political party.~~	37

(2) Each member of the committee shall hold office during the	38
general assembly in which the member is appointed and until a	39
successor has been appointed, notwithstanding the adjournment sine	40
die of the general assembly in which the member was appointed or	41
the expiration of the member's term as a member of the general	42
assembly. Any vacancies occurring among the members of the	43
committee shall be filled in the manner of the original	44
appointment.	45

(C) The speaker of the house of representatives shall	46
designate one of the members of the committee appointed under	47
division (B)(1)(a) of this section to serve as a co-chairperson of	48
the committee. The president of the senate shall designate one of	49
the members of the committee appointed under division (B)(1)(c) of	50
this section to serve as the other co-chairperson. The	51
co-chairpersons shall call the committee to meet at least once	52
each quarter and shall arrange for the medical assistance director	53
to testify before the committee regarding the reforms to be	54
implemented under section 5111.80 of the Revised Code periodically	55
but not more than once each quarter. The co-chairpersons may	56
request assistance and staff support for the committee from the	57
legislative service commission.	58

(D) The committee has the same powers as other standing or	59
select committees of the general assembly. The committee may	60
employ an executive director.	61

Sec. 5111.0126. (A) Subject to division (B) of this section,	62
the medicaid program may cover the group, or one or more subgroups	63
of the group, described in the "Social Security Act," section	64
1902(a)(10)(A)(i)(VIII), 42 U.S.C. 1396a(a)(10)(A)(i)(VIII), if	65
both of the following apply:	66

(1) The federal medical assistance percentage for	67
expenditures for medicaid services provided to the group or	68
subgroup is at least the amount specified in the "Social Security	69
Act," section 1905(y), 42 U.S.C. 1396d(y), as of March 30, 2010;	70

(2) The medicaid program is able to cover the group or	71
subgroup in a manner that causes per recipient medicaid	72
expenditures to be reduced.	73

(B) The medicaid program shall cease to cover the group, and	74
any subgroup of the group, specified in division (A) of this	75
section if the federal medical assistance percentage for	76
expenditures for medicaid services provided to the group or	77
subgroup is lowered to an amount below the amount specified in the	78
"Social Security Act," section 1905(y), 42 U.S.C. 1396d(y), as of	79
March 30, 2010. An individual's disenrollment from the medicaid	80
program is not subject to appeal under section 5101.35 of the	81
Revised Code when the disenrollment is the result of the medicaid	82
program ceasing to cover the individual's group or subgroup under	83
this division.	84

Sec. 5111.80. (A) As used in this section:

"Exchange" has the same meaning as in 45 C.F.R. 155.20.

"Medicaid waiver component" has the same meaning as in	87
section 5111.85 of the Revised Code.	88

(B) Subject to section 5111.801 of the Revised Code, the	89
medical assistance director shall implement reforms to the	90
medicaid program that do all of the following:	91

(1) Improve the health of medicaid recipients while reducing	92
both of the following:	93

(a) The cost of health care;

(b) Uncompensated health care costs.

(2) Control medicaid expenditures and reduce the rate of	96
increase in expenditures;	97

(3) Enroll at least eighty per cent of medicaid recipients in	98
any of the following:	99

(a) The care management system established under section	100
5111.16 of the Revised Code;	101

(b) Group health plans pursuant to section 5111.13 of the	102
Revised Code;	103

(c) A medicaid component established in accordance with the	104
"Social Security Act," section 1906A, 42 U.S.C. 1396e-1, that	105
provides premium assistance subsidies for qualified	106
employer-sponsored coverage to medicaid recipients under nineteen	107
years of age and the parents of such recipients;	108

(d) A medicaid component established in a manner consistent	109
with the definition of "medical assistance" in the "Social	110
Security Act," section 1905(a), 42 U.S.C. 1396d(a), that provides	111
payments for insurance premiums for medical or other type of	112
remedial care for medicaid recipients, other than the following:	113

(i) Recipients who are at least sixty-five years of age;

114

(ii) Recipients who are disabled and entitled to health	115
insurance benefits under the medicare program but not enrolled	116
under part B of the medicare program.	117

(e) A medicaid waiver component that provides premium	118
assistance for medicaid recipients to purchase qualified health	119
plans through an exchange.	120

(4) Require medicaid recipients to assume greater personal	121
responsibility under both of the following:	122

(a) The cost-sharing program instituted under section	123
5111.0112 of the Revised Code;	124

(b) A medicaid component that incorporates the objectives of	125
health savings accounts through value-based insurance designs.	126

(5) Ensure that medicaid recipients who abuse narcotics	127
receive proper treatment and are unable to access the narcotics	128
they abuse through the health care system;	129

(6) Promote employment-related services and job training	130
available under medicaid and other programs to lower medicaid	131
caseloads by assisting able-bodied, adult medicaid recipients into	132
the workforce;	133

(7) Make the administration of the medicaid program more	134
efficient and establish the state as a national leader in	135
preventing medicaid fraud and abuse;	136

(8) Support health care payment innovations in the private	137
sector by assisting other purchasers of health care services and	138
health care providers by leveraging the medicaid program's	139
purchasing power.	140

Sec. 5111.801. (A) The medical assistance director shall	141
implement the reforms under section 5111.80 of the Revised Code in	142
accordance with all of the following:	143

(1) The medicaid state plan approved by the United States	144
secretary of health and human services, including amendments to	145
the plan approved by the United States secretary;	146

(2) Federal medicaid waivers granted by the United States	147
secretary, including amendments to waivers approved by the United	148
States secretary;	149

(3) Other types of federal approval, including demonstration	150
grants, that establish requirements for the reforms;	151

(4) Except as otherwise authorized by a federal medicaid	152
waiver granted by the United States secretary, all applicable	153
federal statutes, regulations, and policy guidances;	154

(5) All applicable state statutes.

155

(B) The medical assistance director shall seek federal	156
approval for all of the reforms to be implemented under section	157
5111.80 of the Revised Code that require federal approval. None of	158
the reforms that require federal approval shall be implemented	159
without receipt of the federal approval. However, a reform that	160
requires federal approval may begin to be implemented before	161
receipt of the federal approval if federal law permits	162
implementation to begin before receipt of the federal approval.	163
Implementation shall cease if federal approval is ultimately	164
denied.	165

Sec. 5111.802. Not later than December 31, 2014, and the	166
last day of each calendar year thereafter, the medical assistance	167
director shall submit to the general assembly, in accordance with	168
section 101.68 of the Revised Code, a full report on the progress	169
being made in implementing the reforms under section 5111.80 of	170
the Revised Code. The report may include recommendations for	171
legislation that would support the reforms.	172

Sec. 5111.947. There is established in the state treasury	173
the Ohio medicaid reform fund. All federal funds the state	174
receives for the federal share of medicaid expenditures for the	175
eligibility group or subgroups authorized by section 5111.0126 of	176
the Revised Code shall be deposited into the fund. All money in	177
the fund shall be used as the federal share of medicaid	178
expenditures for that eligibility group or those subgroups.	179

Section 2. That existing section 101.391 of the Revised Code	180
is hereby repealed.	181

Section 3. The Director of Budget and Management may create	182
any necessary accounts or line items for the Ohio Medicaid Reform	183
Fund established under section 5111.947 of the Revised Code. All	184
money deposited into the Fund under that section during fiscal	185
year 2014 and fiscal year 2015 is hereby appropriated for those	186
fiscal years.	187